NPI | 1922188598 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 105016) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NH 0600) |
Enumeration Date | 2006-10-17 |
Last Update Date | 2007-07-08 |